Reversibility of Acute Demyelinating Lesions in relapsingremitting

Transcription

1 Reversibility of Acute Demyelinating Lesions in relapsingremitting Multiple Sclerosis Omar A. Khan ( Division of Neuroimmunology, Department of Neurology, Neurology and Research Services. Veterans Affairs Medical Center, Baltimore. ) Michael I. Rothman ( Section of Neuroradiology, Department of Diagnostic Radiology, University of Maryland School of Medicine. Baltimore. ) Multiple Sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) of presumed autoimmune etiology and characterized by a relapsing-remitting course 1. Brain magnetic resonance imaging (MRI) has emerged as the most sensitive investigation to detect demvelitiation in MS 2,3. Furthermore, acute relapses of MS have been associated with breakdown of the blood-brain barrier (BBB) 4 seen as contrast enhancement on brain MR( TI-weighted images 5. Recently, we encountered a case of an acute relapse in a patient with known MS. ireatment with h igh-dose intravenous methylprednisolone (IVMP) resulted in clinical recovery as well as resolution of brain MRI abnormalities. This patient represents a striking case of complete reversibility of acute demyelinating lesions seen on brain MRI scans. Case Report A 30 vear old woman with a history of relapsing-remitting MS for several years presented with acute dysarthria, weakness, difficulty in walking and headache of four hours duration. Prior to the onset of symptoms she had been stable for several months. Her only medication was baclofen Vital signs were within normal limits and general physical examination was also normal. Neurological examination was pertinent for mild dysarthria, right hemiparesis, hyperreflexia (more prominent on the right) with bilateral Babinskis signs and spastic ity mild vibratory loss in both distal lower extremities and impaired coordination on the right. She required assistance to ambulate. She was admitted with the diagnosis of acute relapse of MS. Blood counts and routine chemistries were normal. A brain MRI scan with and without contrast was obtained. A well defined area of increased signal intensity adjacent to the anterior horn of left lateral ventricle on axial T2-weighted image was seen (figure I A)

2 with a ring like contrast enhancement seen on axial TI -weighted image (figure 1 B).

3 Treatment with IVMP was instituted at one gram a day for five days followed by a brief taper of oral prednisone. The patient had complete clinical recovery one week after the onset of treatment. A follow up brain MRI scan was obtained two weeks after the first scan. There was significantly diminished signal intensity seen on axial T-2 weighted image (figure 2A)

4 without any enhancement on axial T-1 weighted image (figure 2B).

5 The patient was discharged and continues to do well one year later. Discussion This case highlights the MRI changes seen during an acute demyelinating event associated with clinical

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